My wife and I were travelling through Sialkot in northern Pakistan, visiting family, before going off trekking in the mountains. My cousin knew that I work as a surgeon, and asked if I'd be interested in seeing how surgical instruments are manufactured. Apparently Sialkot produces a staggering 100 million surgical instruments every year, with 1 in 10 going to the NHS.

The conditions were shocking. In my mind I had associated surgical instruments with the clean sterile environment of the operating theatre. But here, they were being made: ground and filed by 10 year-old children working full-time in small open garages on the street. The noise was deafening, the heat and dust unbearable, the risk of serious injury palpable.

The release of the Ethical procurement for health workbook from the British Medical Association and ETI is an important first step in tackling such labour rights issues. It provides NHS institutions with a step-by-step guide on how to harness their purchasing power to improve the situation for workers who make goods, or who supply services, to healthcare: whether that's immigrant workers manufacturing surgical gloves in Malaysia, women sewing nurses uniforms in India, children making surgical instruments in Pakistan, or the cleaners scrubbing hospital wards.

In a way it seems we're onto a winner. The staff in the NHS, and the public, care passionately about the reputation of the NHS, and considering the billions that the NHS spends every year, even relatively modest changes could go a long way. But there are big challenges too. In a time when the NHS is facing the biggest financial crisis in its history, and a proposal from the coalition government for the biggest change to NHS structure, the little voice at the back screaming "ethical procurement" may not get heard.

The NHS Constitution states that it is "accountable to the public, communities and patients it serves". Let's hope it can now extend that accountability to the global communities that supply it.

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ETI's blog covers issues at the intersection of business, news and ethical trade. We welcome a range of insights and opinions from our guest bloggers, though don't necessarily agree with everything they say.